Myeloma Treatment

Chemotherapy is the main treatment for most types of multiple myeloma. Chemotherapy uses medicines to destroy cancer cells. You may receive medicine in a pill, injection or intravenously through your bloodstream. Because different chemotherapy drugs kill cancer cells in different ways, you may receive 2 or more chemotherapy drugs.

You'll receive chemotherapy in courses, or cycles, that can take up to 28 days. A few days between cycles allows your body to rest before the next course. The side effects of chemotherapy may include nausea, vomiting, hair loss, weakness and loss of appetite.

An advanced form of chemotherapy, targeted therapies treat specific aspects of multiple myeloma cells or their growth mechanism. Also called immune modulators, these drugs help the immune system find and attack cancer cells. They are less likely to harm normal cells than chemotherapy. Targeted therapies for multiple myeloma include:

• Proteasome inhibitors: These drugs target the cell enzymes (proteasomes) that help myelomas grow and survive.
• Angiogenesis inhibitors: These prevent the formation of blood vessels that feed tumors or cause changes in cancer cells that make them die.

Side effects of targeted therapies may include disagreeable physical or emotional conditions.

Radiation therapy uses high-energy X-rays to destroy cancer cells within a limited, specific area. It damages the genes in cells to kill cancer cells or stop new cancer cells from forming. Your doctor may recommend getting radiation therapy before a stem cell transplant.

You may receive external radiation therapy with X-rays directed at a certain part of your body. Internal radiation therapy can come orally in pill form or as brachytherapy – radioactive seeds injected into or near a tumor.

Radiation side effects may develop over time and can include nausea, diarrhea and fatigue. You may also experience hair loss and changes to your skin in the treated area.

Multiple myeloma can damage the blood-forming cells in your bone marrow. Bone marrow cells are called hematopoietic stem cells. Those from the bloodstream are called peripheral stem cells. A blood and marrow transplant, also called peripheral blood stem cell transplant, uses healthy blood-forming cells from either bone marrow or the bloodstream to rebuild a healthy blood supply.

Before your blood and marrow transplant you will receive high-dose chemotherapy, which kills cancerous and normal cells in your bone marrow. The blood and marrow transplant replaces them with healthy stem cells to build new bone marrow.

Our physicians have been performing blood and marrow stem cell transplants since 1977. We have the most experienced BMT specialists in the region. Our program is accredited by the Foundation for the Accreditation of Cellular Therapy. We also are a designated National Marrow Donor Program Transplant Center.

Steroids are a common multiple myeloma treatment. Although steroids relieve swelling and inflammation, some also have anticancer effects. Steroids can be used on their own to treat multiple myeloma, or they can be combined with chemotherapy, targeted therapy or both.

Most side effects of steroids go away over time once the drugs are stopped. Some common side effects are feeling hungry, trouble sleeping, slow wound healing, upset stomach and swelling in the ankles, feet and hands.

Two CAR T-cell therapies have been approved for use in patients who have relapsed/refractory multiple myeloma: Abecma® and Carvykti™.

CAR T-cell therapy is chimeric antigen receptor T-cell therapy. It is a form of immunotherapy that works by training a patient’s immune system to find and kill cancer cells. The University of Kansas Cancer Center is the only treatment center in the Kansas City area to offer Abecma, and the only treatment center in the Kansas City area and the state of Kansas to offer Carvykti CAR T-cell therapies to treat relapsed/refractory multiple myeloma.

CAR T-cell therapy reengineers a patient’s immune cells to find myeloma cells and defeat them. These cells, known as T cells, are the backbone of the immune system and normally lead the charge in killing cancer and other harmful cells.

The CAR T-cell therapy process involves separating T cells from the blood and, in a laboratory, genetically engineering them to include synthetic receptors called chimeric antigen receptors (CARs). These reinvigorated cells are then infused back into the patient, newly equipped with receptors that actively search out cancer cells, destroying them as they would a simple pathogen.

Abecma and Carvykti are not first-line treatment and will only be used after other, more traditional therapies, such as chemotherapy, immunotherapy, radiation and stem cell transplants, have been tried and were unsuccessful. Patients who receive Abecma or Carvykti must have relapsed/refractory multiple myeloma after 4 or more prior lines of therapy.

The most common side effect is cytokine release syndrome, which causes symptoms similar to flu. Symptoms can include headache, fever, chills, severe nausea, vomiting, diarrhea, severe muscle or joint pain, shortness of breath, low blood pressure and rapid heart rate.

Bispecific T-cell engagers are a form of immunotherapy that use the patient’s own immune cells, the T cells, to engage and destroy the cancer cells. A bispecific antibody can be described as a 2-forked molecule that forms a bridge between cancer cells and T cells. One fork attaches to the T cell and the other fork attaches to the cancer cell. This allows the T cell to get close to the cancer cell, punch a hole in it and destroy it. Bispecific T-cell engager immunotherapies that we offer and are approved by the US Food and Drug Administration to treat multiple myeloma include:

• Teclistamab (brand name Tecvayli™) was the first FDA-approved bispecific antibody that targets B-cell maturation Ag (BCMA) to treat refractory or relapsed multiple myeloma in adults who have received at least 4 prior lines of therapy.
• Talquetamab-tgvs (brand name Talvey™) is a bispecific T-cell engaging antibody that binds to the CD3 receptor on the surface of T cells. It is approved for the treatment of adult patients with relapsed or refractory multiple myeloma who have received at least 4 prior lines of therapy. It is approved as a weekly or biweekly injection.
• Elranatamab-bcmm (brand name Elrexfio™) is a BCMA-targeting bispecific antibody approved for the treatment of adult patients with relapsed or refractory multiple myeloma who have received at least 4 prior lines of therapy. It is approved as a weekly or biweekly injection

Rarely used to treat multiple myeloma, you may require surgery to remove a solitary plasma cell tumor located outside of the bone or to repair a bone fracture caused by multiple myeloma. Side effects of surgery may include weakness, fatigue and pain after the surgery. Other common side effects are swelling, surgical scars and, less frequently, infections.